Evaluation and Management of Urgency and Urge Urinary Incontinence in Men
TL;DR: The evaluation of the male patient with overactive bladder symptoms such as urgency and urge incontinence is discussed, and the different therapeutic options available for management of men with OAB are explored.
Abstract: The overactive bladder (OAB) syndrome is increasingly being recognized as a major contributor to the lower urinary tract symptoms in men previously thought to be only due to bladder outlet obstruction from benign prostatic hyperplasia. Medical and surgical treatments that have historically been used to treat women with OAB are being applied to men with great efficacy and a good safety profile. Additionally, treatments such as the β-3 agonist mirabegron, phosphodiesterase-5 inhibitors, sacral and peripheral neuromodulation, and intravesical botulinum toxin injection are promising emerging therapies for the OAB syndrome. This review discusses the evaluation of the male patient with OAB symptoms such as urgency and urge incontinence, and explores the different therapeutic options available for management of men with OAB.
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01 May 2017
TL;DR: A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER of Science in Nursing Science.
Abstract: A Project Submitted in Partial Fulfillment of the Requirements
for the Degree of
MASTER OF SCIENCE
in
Nursing Science
7 citations
Cites background or methods from "Evaluation and Management of Urgenc..."
...And recently, a new class of medication for overactive bladder (OAB) has been approved by the FDA....
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...Timed voiding decreases incontinence symptoms Behavioral Therapies 32 Stothers, Thom & Calhoun, 2010 Literature Review V/A N/A Anticholinergic meds more effective than placebos Pharmacological Therapy Article # Author & Date Evidence Type Level of Evidence /Quality Sample Size Study Findings that Answer the Question Main Idea 33 Weber & Roberts, 2015 Records Review III....
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...The new β-3 adrenoreceptor agonists might also be effective in this population, although this has not been investigated (Hollander and Gonzalez, 2012)....
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...population, although this has not been investigated (Hollander and Gonzalez, 2012)....
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...Pharmacological Therapies Article # Author & Date Evidence Type Level of Evidence /Quality Sample Size Study Findings that Answer the Question Main Idea 9 Nazarko, 2015 Expert Opinion IV/A N/A Correctly assessing a patient’s type of continence and selecting the appropriate type of continence pad is necessary when treating patients living with urinary incontinence....
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TL;DR: The prevalence of chronic and debilitating symptoms of the overactive bladder are determined as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.
Abstract: Objective To determine the prevalence of chronic and debilitating symptoms of the overactive bladder, defined here as the presence of chronic frequency, urgency and urge incontinence (either alone or in any combination), and presumed to be caused by involuntary detrusor contractions.
Subjects and methods Data were collected using a population-based survey (conducted by telephone or direct interview) of men and women aged 40 years, selected from the general population in France, Germany, Italy, Spain, Sweden and the United Kingdom, using a random stratified approach. The main outcome measures were: prevalence of urinary frequency (> 8 micturitions/24 h), urgency and urge incontinence; the proportion of participants who had sought medical advice for symptoms of an overactive bladder; and current or previous therapy received for these symptoms.
Results In all, 16 776 interviews were conducted in the six European countries. The overall prevalence of overactive bladder symptoms in individuals aged 40 years was 16.6%. Frequency (85%) was the most commonly reported symptom, followed by urgency (54%) and urge incontinence (36%). The prevalence of overactive bladder symptoms increased with advancing age. Overall, 60% of respondents with symptoms had consulted a doctor but only 27% were currently receiving treatment.
Conclusion Symptoms of an overactive bladder, of which frequency and urgency are as bothersome as urge incontinence, are highly prevalent in the general population. However, only a few affected individuals currently receive treatment. Taken together, such findings indicate that there is considerable scope for improvement in terms of how physicians diagnose and treat this condition.
1,544 citations
"Evaluation and Management of Urgenc..." refers background in this paper
...Although classically thought of as a symptom associated with women, it is now recognized that the OAB syndrome is very common in men and increases with age [1]....
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TL;DR: The importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction.
Abstract: Little is known about the causes of urinary incontinence in institutionalized elderly people, despite the fact that $8 billion is annually devoted to diapering those afflicted. We have identified a specific physiological abnormality— detrusor hyperactivity with impaired contractile function (DHIC)—that, although previously unrecognized, is the second most common (33%) cause of incontinence in this setting. Detrusor hyperactivity with impaired contractile function is a distinct physiological subset of detrusor hyperreflexia and presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This impaired emptying is due to diminished detrusor contractile function and is associated with bladder trabeculation, a slow velocity of bladder contraction, little detrusor reserve power, and a significant amount of residual urine. Aside from its high prevalence, the importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction. Furthermore, DHIC may represent a more advanced stage in the natural history of detrusor hyperreflexia, a stage characterized by deterioration of detrusor contractile efficiency. Thus, this previously unrecognized cause of incontinence in the elderly is common and raises several important issues. (JAMA1987;257:3076-3081)
430 citations
"Evaluation and Management of Urgenc..." refers background in this paper
...This group of patients includes patients with detrusor underactivity and another group previously described as having detrusor hyperactivity with impaired contractility [6]....
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TL;DR: The compelling efficacy of percutaneous tibial nerve stimulation demonstrated in this trial is consistent with other recently published reports and supports the use of peripheral neuromodulation therapy for overactive bladder.
425 citations
TL;DR: Results of this prospective, randomized clinical study demonstrate that sacral nerve stimulation is effective for restoring voiding in patients with retention who are refractory to other forms of treatment.
304 citations
TL;DR: Although statistically significant, the differences between anticholinergic drugs and placebo were small, apart from the increased rate of dry mouth in patients receiving active treatment.
Abstract: Objective: To determine the effectiveness of anticholinergic drugs for the treatment of overactive bladder syndrome. Design: Systematic review of randomised controlled trials. Data sources: Published papers and abstracts. Study selection: Randomised controlled trials with anticholinergic drug treatment in one arm and placebo in another. Data extraction: Primary outcomes of interest were patient perceived cure or improvement in symptoms, differences in number of incontinent episodes and number of voids in 24 hours, and side effects. Secondary outcomes of interest were urodynamic measures of bladder function (volume at first contraction, maximum cystometric capacity, and residual volume) and adverse events. Data synthesis: 32 trials were included, totalling 6800 participants. Most trials were described as double blind but were variable in other aspects of quality. At the end of treatment, cure or improvement (relative risk 1.41, 95% confidence interval 1.29 to 1.54), differences in incontinent episodes in 24 hours (estimated mean difference 0.6, 0.4 to 0.8), number of voids in 24 hours (0.6, 0.4 to 0.8), maximum cystometric capacity (54 ml, 43 ml to 66 ml), and volume at first contraction (52 ml, 37 ml to 67 ml), were significantly in favour of anticholinergics (P Conclusions: Although statistically significant, the differences between anticholinergic drugs and placebo were small, apart from the increased rate of dry mouth in patients receiving active treatment. For many of the outcomes studied, the observed difference between anticholinergics and placebo may be of questionable clinical significance. None of these studies provided data on long term outcome. What is already known on this topic Anticholinergics are the first line medical treatment for overactive bladder The effectiveness of these drugs is unclear What this study adds Anticholinergics produce significant improvements in overactive bladder symptoms compared with placebo The benefits are, however, of limited clinical significance
304 citations